Nineteenth Century Medical Guide

Chapter 85 82. Sir, this neck is not easy to handle

Before the crossing, Carvey stayed in a trauma center based on a large general hospital, which mainly dealt with burns, traffic accidents, high falls and some complicated traumas.He has been transferred to work there since the center was founded, and he has been working there for more than 30 years.

When it comes to dealing with trauma, it is not an exaggeration to praise him for his ease of use.

Li himself had many wounds, involving the maxillofacial region, nose, forearm, thigh and important neck.

Knife wounds need to be classified into types. Horizontal cutting wounds are often shallower than vertical stabbing wounds, and it is difficult to touch deep tissues. However, because of the larger injury range, it will have a greater impact on important nerves and blood vessels located in the superficial layers.

Judging from Li Ben's reaction and the amount of bleeding at the scene, Nora's attack was still a little light, and his height and strength were limited, so he was not killed on the spot.

As long as there is a chance, Carvey will save him, not because of the lofty concept of "saving people is a doctor's bounden duty", saving people has already been engraved into the bone marrow, it is considered instinct.

What really drove him to make a decision was something more selfish, such as "satisfiing his little vanity by completing some difficult challenges".Otherwise, he would not have been able to work for so many years in the pit of the trauma center for self-entertainment.

Of course, from the 21st century to the 19th century, the lack of medical norms and systems, and the existence of surgical theaters have created a certain amount of evil in his heart.Although it will not obliterate the most basic professional ethics, it is still possible to disgust scum according to contemporary "medical norms".

The premise of disgusting people is that the other party is still a living person, and Li Ben must be revived first.

The current situation is not complicated. The people living on Tony Linton Street are all poor people at the bottom, and they have to go to the crowded Hoynz Street to get a carriage.And those coachmen will not pay attention to the poor. Only when the police come can they be persuaded to go into the dark alley to save people.

When the carriage is in place, people are carried into the carriage, and it may take an hour before they are actually admitted to the hospital. The bleeding must be stopped on the spot.

What Carvey needs to do is to make a simple judgment on the wound that may cause massive bleeding, and then sort out the order of suturing and ligation to stop bleeding, and then perform ligation in turn.

Judging from these active bleeding wounds, the more important ones are the neck and thighs.

"You covered your neck and thighs, let me see how your leg is hurting first."

Kavi took his pulse first, and then cut open his trousers when he found it passable. The accumulated blood inside flowed down, and an uncomfortable smell of blood filled the air.

Li Ben's left thigh was cut from the outside to the inside. Because of the low position, he avoided the superficial femoral artery and vein and the deep femoral artery and vein that run at a high position. He only cut the vastus lateralis muscle and rectus femoris.

The blade didn't penetrate too much, and it left the thigh without touching the vastus medialis muscle near the blood vessel. Judging from the trajectory, it should hurt some branches of the descending branch of the lateral circumflex femoral artery.It's just that the amount of bleeding from the wound on the leg is average, and it can't be seen for the time being. 【1】

In comparison, neck wounds are much more serious.

If it is placed in modern times, this kind of neck cut injury of about 10cm should be bandaged first, regardless of the degree of injury, and then carefully explored after entering the operating room with complete conditions.

But now Carvey has no operating room, no reliable trauma team, no stable anesthesia, and no time to go to the hospital. Bandaging first will definitely further affect the airway, so he still wants to take the risk to judge the specific location based on his own experience. 【2】

Carvey picked up a still-lit candle from the ground and approached it: "Continue to press the leg, let me see the neck."

Li Ben slowly moved his hand away, and soon a lot of blood oozes from the neck wound, and the amount of bleeding is not small.

The skin on the entire neck was tight and hard to the touch, as if a small hematoma had formed.After a brief glance, Carvey put his hand back to the original place and pressed it. It was preliminarily judged that the deep blood vessels had been damaged, the anterior neck muscles were broken and the sternocleidomastoid muscle was damaged. .

The deep large blood vessels are protected by the carotid sheath, but the shape is superficial. The internal jugular vein may have been ruptured, and the situation of deeper arteries is unknown. 【3】

Li Ben could clearly feel that his neck was bleeding, and his survival instinct made him say: "You are a doctor, you must save me."

Carvey sighed, patted him on the shoulder without saying a word, and checked the situation on his arm again.

There were two obvious cuts on the left forearm, luckier than the thigh, but the lateral brachioradialis muscle and the brachiolateral extensor carpi longus were cut, the blood vessels under the muscles were not touched, and the amount of bleeding was limited. 【4】

Others, such as the face and nose, although it looks exaggerated, are actually just ordinary cutting trauma, no important blood vessels are injured, and the bleeding will soon stop on its own.

Now the order is obvious, neck > thigh > forearm, and the facial problem will wait until the hospital.

He needs to find the ruptured blood vessel in the neck as soon as possible, and sew it if he can, or bandage it if he can't.When I go back to the hospital and find Ignatz and Herman, I should be able to keep him alive with help.

But Carvey couldn't cheer up.
Li Ben watched him retreat slowly, found a chair and moved it beside him, sat down firmly, really didn't understand what kind of medicine was sold in the gourd: "Doctor, I'm dying of pain, why are you still standing there? "

"It's okay, I've sent someone to call the police."

"police?"

"Ah."

Probably because he lost a lot of blood, Li Ben was dazzled after hearing this: "What's the use of the police coming?"

"It's very expensive to send the police to the carriage and send it to the hospital." Kavey paused, then continued, "By the way, I can also help you identify the injury, whether it is a minor injury or a serious injury."

"I'm dying!"

Li Ben's voice is not loud, but these words are full of momentum, but it's a pity that Carvey doesn't like this set: "According to the four fluids theory of Hippocrates and Galen, bloodletting is good for health. I just read it, but it's not very good. It's just a big wound that will heal slowly."

"Uh-huh?"

If it wasn't for the intense physical feeling, Li Ben would have believed it: "You can't let the bloodletting go indiscriminately, right? The wound is so big, I feel like I'm dying."

"I'm just a little assistant, how can I help you?" Kavey replied casually, picked up a rag beside him and wiped his hands, "I think it's better to let the police call the carriage first, and then go to the hospital and let Ignatz Teacher, save him, he is much better than me."

"The assistant is half a doctor, and I'm a patient." Li Ben was a little dizzy, knowing that he couldn't delay, so he could only insist on maintaining the patient-patient relationship between the two. "It's only natural for a doctor to save a patient."

"Oh, you said that you are a patient, and I want to save you. When you bullied Nora, did you ever think that she is also my patient, should I save her?"

When Carvey thought that the perfect operation he had just performed was almost ruined by the man in front of him, he felt extremely bad: "I don't care about her life, or where she will go in the future, I only care about her wounds, she is my The first patient to be operated on by the surgeon.”

"."

The dripping blood gradually overflowed, and Li Ben kept sliding down because of the thick blood around his body.He pressed his leg with his left hand, and blocked his neck with his right hand. He could only use his right leg to push the ground to barely maintain a sitting position: "It's my fault, I don't know, I don't know that she is your patient."

"I know now."

"I apologize, I admit my mistake."

"Just an apology?"

"I'll pay, I can pay!" Li Ben looked down at his pocket, "I have 237 crowns on me, I'll give it all to you, you must save me!"

"It's almost there."

Carvey nodded slightly, and gave him a brief introduction: "The left leg injured a muscle and a branch blood vessel. Suturing it is not realistic, and local compression can be done. The left arm only injured a muscle, not too deep, and the blood vessel problem is not serious. .The face and nose are fine."

"What about the neck?"

Cavet deliberately left the neck that bleeds the most for the end: "The problem is the neck, Sir, this neck is not easy to handle."

"It's difficult? Why is it difficult?"

Li Ben was also a person who had been on the battlefield. He knew very well that his neck bleeds the most, followed by his legs.

At this time, he didn't care about his status and dignity, and he said quickly: "Your name is Kawei, I read the newspapers, and you are the youngest genius surgeon they say. I am still alive, still alive, You can definitely do it!"

"No, Mr. Li Ben, you misunderstood."

Carvey made a gesture and corrected the misunderstanding in time: "I mean, the neck muscles are very thin, and the blood vessels are abundant and very close to the skin. Neck wounds can easily damage the blood vessels. Once the blood vessels are injured, it must be extremely difficult to stop the bleeding." .
So you have to add money! "

Li Ben didn't understand what he was saying at all, he just asked, "How much does it cost?"

"Help Mr. Laszlo do a gas cut. He gave me an apartment. You are a majestic Sir of the Great German Empire. This neck is worth 2000 crowns anyway."

"what?!"

Li Ben's fractured anterior neck muscles affected the movement of his throat, so he had to continue to put more effort into his neck, but his momentum had been reduced by more than half, and his head became more and more dizzy: "2000? Where can I find 2000 crowns? !"

"Speak softly, don't yell," Carvey advised, "Your neck is bleeding again."

"You might as well just kill me"

"Don't be kidding, I'm a doctor, how can I kill people." Kavi got up and moved the equipment box, took out the wallet from his trouser pocket and took out two 100-kroner bills: "Receive people's money and help people eliminate disasters." 100 crowns for the legs, 50 for the arms, 50 for the face and nose, exactly 200. Keep the change for yourself and buy something delicious.”

"What about the neck?"

"2000, I just said it."

Carvey can't control these things, he has to work after receiving the money, and sewing off the wounds on his hands and legs first can also reduce some bleeding: "The heart rate is over 100, and the bleeding is indeed a bit heavy."

"I'm dizzy and have no energy"

"It's okay, I think you can still bear it."

Kavi looked at his neck again, and after finding that it was the same as before, he took the crow beak pliers and tweezers from the box.He handed the candle to Li Ben, and took advantage of the light to search for blood vessels in his legs. Every step made Li Ben scream like a pig.

"Hey, put the candle right, I won't be able to find the blood vessel if you do this."

Kavi pressed the blood-soaked wound with gauze, and the pain caused Li Ben to tense all his muscles: "My wife hurts."

"Nonsense, can it not hurt?"

"Can you."

"It's not light! Also, please relax!" Carvey patted the muscles around his wound, and helped straighten the candle again, "Don't move it this time, I won't look for it if you move it again."

Li Ben gritted his teeth and nodded: ".Okay!!!"

The condition of the thigh was indeed similar to what Carvey thought. Several small blood vessel branches were broken, but fortunately, the descending branch of the lateral circumflex femoral artery was not broken, so luck was good.Suturing the delicate blood vessels is definitely impossible. What he can do now is to suture off these bleeding points that keep bleeding out as soon as possible.

As for the blood supply to the skin of the corresponding muscles, never mind.

With no worries about the prognosis, Carvey was very fast. The catgut was done to stop the bleeding, the muscles and fascia were sewn on, and finally the skin was sewn on with silver thread. The process was done in one go.The incision on the arm was simpler. By the time Carvey made the probe, the blood had basically stopped, and only a simple suture was needed.

Li Ben was in excruciating pain, but he still had to sigh: This guy's technique is too good.

"There's no need to worry about the split nose, you can go back to the hospital." Carvey picked up the candle and looked carefully at the wound on his face, "The knife wound on his face is also okay, I'll sew it up for you now But what's the matter with the ring of teeth marks on your mouth?"

Li Ben said helplessly, "I was bitten by her."

Carvey smiled and shook his head: "I can't sew the tooth marks, and I don't need to sew them. Just keep them."

Li didn't have time to look in the mirror, but he could basically guess that his face must be impossible to see: "It's too ugly to keep it."

"Do you want to dig it out?" Carvey explained with a smile, "The bite is not easy to deal with. It's not bad if it grows well. Do you still care about looking good?"【5】

Li Ben had no choice but to agree with his solution: "Then what about my neck?"

"2000 crowns."

"Farewell, Dr. Carvey, you know, I don't have that much money." Li Ben smiled wryly, almost worshiping him as God, "Change the terms, as long as it can be done, I will agree."

Carvey took the pulse again, the heart rate was slightly faster than before, and the bleeding in the neck continued.Considering that a lot of blood will be shed during the investigation, Li Ben must have enough blood volume to do it, and he can't delay any longer.

"It's not impossible." Carvey said, "You have to admit that you did it first."

"No problem, I want it, I want to qj her, it's my fault, my fault!"

"No, it's not this." Carvey rummaged through the kitchen, picked up the stick that Fleurney used from the floor, and stuffed it into his hand, "You have to admit that you wanted to kill her first, she completely It was out of necessary resistance that I wounded you like this with a knife."

Li Ben looked at the stick and quickly shook his head: "This logic doesn't make sense. If she hadn't sneaked up and hurt my leg first, how could she have won against me?"

"Are you talking about logic with me? According to logic, don't sew your neck, and wait for the carriage obediently."

"don't don't"

Li originally wanted Carvey to save himself, but he didn't want to admit that he had done these things, so he had to show his hole card: "If it really doesn't work, you can go and talk to Mr. Meek. He should be able to help pay for it."

What Carvey wanted was never money, but to get Nora off the hook.

Now that he suddenly heard Mick's name, his nerves were even more stimulated. He picked up the box and was about to go out: "I'd better go and see if Nora is injured. Take care."

"Don't, don't go!" Li Ben didn't care about the blood oozing from his neck, and hurriedly said, "I'm very useful to Mr. Meek. He won't die. You can talk to him about many conditions. Believe me , it’s all true!!!”

"I'm not interested in your affairs." Carvey sighed and said back, "If you refuse to agree, just sit and wait for the carriage, it should be here soon."

　Mick has been completely reduced to a marginal role, don't worry about the intersection, but you still have to use it
　　I'm on duty tonight, there should be another shift in the middle of the night, oh, don't come to the emergency room, Methofo
　　
　
(End of this chapter)